The Eosinophilic

Pneumonias
Dr Rajesh Padhi MD,DipCard,FCCP
The Eosinophilic Pneumonias

Definition: Eosinophilic pneumonias

includes all disorders characterized by
infiltration of the lungs with eosinophils, with
or without an excess of eosinophils in the
peripheral blood.
 Diseases Associated with Pulmonary
Infiltrates and Eosinophilia

Pulmonary Eosinophilic Syndromes of Known

Cause
1. Parasitic-Drug-or toxin induced eosinophilic
pneumonias (including Loeffler’s syndrome)
2. Tropical pulmonary eosinophilia
3. Allergic bronchopulmonary mycosis/Aspergilosis
(ABPA)
 Pulmonary Eosinophilic Syndromes of
Unknown Cause

1. Idiopathic acute eosinophilic pneumonia

2. Chronic eosinophilic pneumonia
3. Churg-Strauss syndrome (allergic
granulomatosis and angiitis)
4. Idiopathic hypereosinophilic syndrome
 Parasitic Infections Associated with
Eosinophilic Pneumonia
Ancylostoma spp.
Opisthorchis spp.
Ascaris spp.
Paragonimus westermani
Brugia malayi
Schistosoma spp.
Clonorchis sinensis
Strongyloides stercoralis
Toxocara gondii
Wuchereria bancrofti
Loeffler’s Syndrome (Simple Pulmonary
Eosinophilia

Definition:
Loeffler’s Syndrome is a clinical
syndrome characterized by mild respiratory
symptoms, peripheral blood eosinophilia,
and transient, migratory pulmonary
infiltrates.
 Etiolopathogenesis

Immune hypersensitivity to Ascaris lumbricoides

Ascaris larvae.
Exposures to numerous drugs and other
agents
 Ing
esti
on

Enter alveoli Lav

->adult worm a in
SI

Cross
intestinal
The pulmonary manifestations of Loeffler’s
syndrome begin approximately 9 to 12 days
following ingestion, and occur during the
migration of larvae through the lung.
 CLINICAL FINDINGS

1. Affects people of all ages.

2. Low-grade fever
3. Nonproductive cough, dyspnea
4. hemoptysis.
5. self-limited (1 to 2 weeks)
6. PSC: moderate to extremeeosinophilia
7. Sputum: contains eosinophils.
8. CXR: Transient, migratory, nonsegmental
interstitial and alveolar infiltrates (often
peripheral or pleural based)
9. PFT: reveals a mild to moderate restrictive
ventilatory defect
10. DLCO: reduced diffusing capacity for carbon
monoxide
11. Lung biopsy: eosinophilic infiltration of
interstitium and alveolar-capillary units
 RX

Search for an etiologic agent (e.g., parasitic infection

or drug reaction)
Causative Drugs & agents to be stopped
Bronchodilators
rarely corticosteroids may be used for alleviation of
symptoms (self-limited)
Ascaris, treatment with oral mebendazole
(100 mg twice a day for 3 days)
 Drugs and Other Exposures Causing
Eosinophilic Pneumonia

Rapeseed oil
Red spider antigen
Acetylsalicylic acid
Amiodarone
Captopril
Carbamazepine
Phenytoin
Sulfasalazine
 Diagnostic Criteria for Allergic
Bronchopulmonary Aspergillosis
Major Criteria
Asthma
Positive immediate hypersensitivity skin-prick test to
Aspergillus
Precipitating antibodies against Aspergillus
Elevated total IgE
Elevated serum Aspergillus–specific IgE, IgG
History of pulmonary infiltrates
Peripheral blood eosinophilia
+/− Proximal bronchiectasis
 Diagnostic Criteria for Allergic
Bronchopulmonary Aspergillosis
Minor Criteria

Mucous plugs containing Aspergillus

Dual cutaneous reaction to Aspergillus